SOGC CLINICAL PRACTICE GUIDELINE
No. 280 (Replaces No. 131, August 2003)
Emergency Contraception
This clinical practice guideline has been prepared by
the Social and Sexual Issues Committee, reviewed by
the Clinical Practice Gynaecology Committee and the
Family Practice Advisory Committee, and approved by the
Executive and Council of the Society of Obstetricians and
Gynaecologists of Canada.
PRINCIPAL AUTHORS
Sheila Dunn, MD, Toronto ON
Édith Guilbert, MD, Quebec QC
SOCIAL SEXUAL ISSUES COMMITTEE
Margaret Burnett, MD (Chair), Winnipeg MB
Anjali Aggarwal, MD, Toronto ON
Jeanne Bernardin, MD, Moncton NB
Virginia Clark, MD, Golden BC
Victoria Davis, MD, Scarborough ON
Jeffrey Dempster, MD, Halifax NS
William Fisher, PhD, London ON
Karen MacKinnon, RN, PhD, Victoria BC
Rosana Pellizzari, MD, Peterborough ON
Viola Polomeno, RN, PhD, Ottawa ON
Maegan Rutherford, MD, Halifax NS
Jeanelle Sabourin, MD, Edmonton AB
Vyta Senikas, MD, Ottawa ON
Marie-Soleil Wagner, MD, Montreal QC
Disclosure statements have been received from all members of
the committee.
The literature searches and bibliographic support for this
guideline were undertaken by Becky Skidmore, Medical
Research Analyst, Society of Obstetricians and Gynaecologists
of Canada.
Key Words: Emergency contraception, post-coital contraception,
emergency contraceptive pills, post-coital copper intrauterine
device, IUD
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information
should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate
amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be
reproduced in any form without prior written permission of the SOGC.
870 l SEPTEMBER JOGC SEPTEMBRE 2012
Abstract
Objective: To review current knowledge about emergency
contraception (EC), including available options, their modes of
action, efficacy, safety, and the effective provision of EC within a
practice setting.
Options: The combined estradiol-levonorgestrel (Yuzpe regimen)
and the levonorgestrel-only regimen, as well as post-coital use of
copper intrauterine devices, are reviewed.
Outcomes: Efficacy in terms of reduction in risk of pregnancy, safety,
and side effects of methods for EC and the effect of the means
of access to EC on its appropriate use and the use of consistent
contraception.
Evidence: Studies published in English between January 1998 and
March 2010 were retrieved though searches of Medline and the
Cochrane Database, using appropriate key words (emergency
contraception, post-coital contraception, emergency contraceptive
pills, post-coital copper IUD). Clinical guidelines and position
papers developed by health or family planning organizations were
also reviewed.
Values: The studies reviewed were classified according to criteria
described by the Canadian Task Force on Preventive Health Care,
and the recommendations for practice were ranked according to
this classification (Table 1).
Benefits, Harms, and Costs: These guidelines are intended to help
reduce unintended pregnancies by increasing awareness and
appropriate use of EC.
Sponsor: The Society of Obstetricians and Gynaecologists of
Canada.
Summary Statements
1. Hormonal emergency contraception may be effective if used up to
5 days after unprotected intercourse. (II-2)
2. The earlier hormonal emergency contraception is used, the more
effective it is. (II-2)
3. A copper IUD can be effective emergency contraception if used
within 7 days after intercourse. (II-2)
4. Levonorgestrel emergency contraception regimens are more
effective and cause fewer side effects than the Yuzpe regimen. (I)
5. Levonorgestrel emergency contraception single dose (1.5 mg) and
the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have
similar efficacy with no difference in side effects. (I)
J Obstet Gynaecol Can 2012;34(9):870–878

Table 1. Key to evidence statements and grading of recommendations, using the ranking of the Canadian Task Force
on Preventive Health Care
Quality of evidence assessment*
I: Evidence obtained from at least one properly randomized
controlled trial
II-1: Evidence from well-designed controlled trials without
randomization
II-2: Evidence from well-designed cohort (prospective or
retrospective) or case–control studies, preferably from
more than one centre or research group
II-3: Evidence obtained from comparisons between times or
places with or without the intervention. Dramatic results in
uncontrolled experiments (such as the results of treatment with
penicillin in the 1940s) could also be included in this category
III: Opinions of respected authorities, based on clinical experience,
descriptive studies, or reports of expert committees
*The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on
Preventive Health Care.73
†Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force
on Preventive Health Care.73
6. Of the hormonal emergency contraception regimens available in
Canada, levonorgestrel-only is the drug of choice. (I)
7. A pregnancy that results from failure of emergency contraception
need not be terminated (I)
Recommendations
1. Emergency contraception should be used as soon as possible
after unprotected sexual intercourse. (II-2A)
2. Emergency contraception should be offered to women if
unprotected intercourse has occurred within the time it is known to
be effective (5 days for hormonal methods and up to 7 days for a
copper IUD). (II-2B)
3. Women should be evaluated for pregnancy if menses have
not begun within 21 days following emergency contraception
treatment. (III-A)
4. During physician visits for periodic health examinations or
reproductive health concerns, any woman in the reproductive
age group who has not been sterilized may be counselled about
emergency contraception in advance with detailed information
about how and when to use it. (III-C)
INTRODUCTION
Emergency contraception refers to all methods of
contraception that are used after intercourse and before
implantation. The most commonly used methods can
reduce the risk of pregnancy by 75% to 89%.1–3 The EC
ABBREVIATIONS
EC emergency contraception
EE ethinyl estradiol
LNG levonorgestrel
Emergency Contraception
Classification of recommendations†
A. There is good evidence to recommend the clinical preventive action
B. There is fair evidence to recommend the clinical preventive action
C. The existing evidence is conflicting and does not allow to make a
recommendation for or against use of the clinical preventive action;
however, other factors may influence decision-making
D. There is fair evidence to recommend against the clinical preventive action
E. There is good evidence to recommend against the clinical preventive
action
L. There is insufficient evidence (in quantity or quality) to make
a recommendation; however, other factors may influence
decision-making
methods are intended for occasional use, primarily as a
backup to regular methods of birth control.
Emergency contraception has been available in Canada
for almost 30 years, but as of 2002 only 57% of Canadian
women were familiar with it.4 Forty to fifty percent of
pregnancies in Canada remain unplanned despite the wide
availability of contraceptive methods,5,6 and in 2006, 91 310
abortions were performed in Canada.7 The appropriate use
of EC may reduce the number of unintended pregnancies.
METHODS OF EMERGENCY CONTRACEPTION
There are 2 methods of emergency contraception available
in Canada: hormonal methods, also known as emergency
contraceptive pills, and post-coital insertion of a copper
intrauterine device.
Three products, Plan B, NorLevo, and Next Choice, are
approved in Canada as hormonal EC. The first 2 consist
of 2 tablets of levonorgestrel 750 μg taken as a single dose.
The third consists of 2 tablets of levonorgestrel 750 μg
taken 12 hours apart. All are now available in participating
Canadian pharmacies without a prescription.8
The other hormonal EC, known as the Yuzpe method,1 has
been in use since the 1970s, and consists of 2 tablets of Ovral
(50 μg of ethinyl estradiol and 250 μg of levonorgestrel)
taken orally and repeated 12 hours later. Occasionally, an
antiemetic is also required. Other contraceptive pills can
be substituted if they are more readily available, as they are
SEPTEMBER JOGC SEPTEMBRE 2012 l 871
SOGC CLINICAL PRACTICE GUIDELINE
considered to offer equivalent efficacy,9 although they may
not deliver an exactly equivalent dose (Table 2). None of
these combined hormonal products have been approved
for use as EC in Canada. Nonetheless, they may still be
used for this purpose as they are readily available (on
prescription) and economical.
The antiprogestin mifepristone (RU 486) has been shown
to be a highly effective post-coital contraceptive,10–14 but
this product is unlikely to be available to Canadian women
in the near future. Another antiprogestin, ulipristal acetate,
has been found to be at least as effective as levonorgestrel
emergency contraception and was approved in 2010 by the
United States Food and Drug Administration but has not
yet been approved by Health Canada.15,16
The insertion of a copper IUD within 5 days of
unprotected intercourse has been shown to prevent
pregnancy.17–19 The use of a post-coital copper IUD
between 5 and 7 days after unprotected intercourse is
less well studied, although some trials have extended the
treatment window to 7 days.18,20 If successful in preventing
pregnancy, the copper IUD may remain in place to provide
ongoing contraception. Flexi-T and Nova-T are the 2
copper-bearing IUDs currently licensed for contraceptive
use in Canada. Both are prescription products and may
used “off-label” for EC. The levonorgestrel intrauterine
system (Mirena intrauterine system) is not currently
recommended for use as EC.21
MECHANISM OF ACTION OF
EMERGENCY CONTRACEPTION
The exact mechanisms of action of emergency contraceptives
are unclear, but EC could theoretically interfere with
follicle maturation, the ovulatory process, cervical mucus,
sperm migration, corpus luteum sufficiency, endometrial
receptivity, fertilization, or zygote development, transport,
or adhesion.22 The mechanism of action may differ not
only with the different EC regimens, but also within each
regimen, depending upon when it is given relative to the
time of both intercourse and ovulation.22
Statistical evidence of the effectiveness of hormonal
EC agrees with clinical data, suggesting that the main
mechanism of action is related to interference with
ovulation.22–28 When given before ovulation, the Yuzpe
EC, levonorgestrel-only EC, and mifepristone appear to
suppress or delay ovulation22–26; if ovulation does occur,
it appears to be dysfunctional.23,25,26 When EC is given
at the time of or after ovulation, no effect on ovulation
is seen.23,24,26 Recent data show that LNG-EC prevents
pregnancy only when taken before fertilization of the
872 l SEPTEMBER JOGC SEPTEMBRE 2012
ovum has occurred.29,30 It appears unlikely that EC has an
effect on the luteal phase.22–26,30
Studies of the effects of combined EC and levonorgestrel-
only EC (LNG-EC) on the endometrium are not consistent;
however, most recent studies have failed to show major
alterations in the mechanisms associated with endometrial
receptivity.22,23,25–27,30 Since the effect on ovulation may not
explain the total effectiveness of hormonal EC,31,32 more
clinical data are required to assess the contribution of
other mechanisms of action.
EFFICACY
Hormonal Regimens
The Yuzpe and levonorgestrel-only regimens have been
shown to reduce the risk of pregnancy by about 75% to
89%, respectively,1–3,33 but this does not mean that up to
25% of women using the Yuzpe regimen will become
pregnant. Theoretically, if 100 women had unprotected
intercourse once during the second or third week of their
cycle, about 8 would become pregnant; following treatment
with the Yuzpe regimen, only 2 would become pregnant,
a reduction of 75%.34 However, recent studies using
statistical estimation of the effectiveness of hormonal EC
suggest that the risk reduction may not be this great.35,36
The World Health Organization reports a pregnancy rate
of 1.1% with the levonorgestrel-only regimen compared
with 3.2% for the Yuzpe regimen.1
Two randomized trials1,3 compared levonorgestrel given
twice 12 hours apart with the Yuzpe regimen, and both
showed that levonorgestrel only had higher efficacy
(85% vs. 57% for typical use and 89% vs. 76% for
perfect use).1
In 2002, 2 large randomized trials37,38 showed that a single
dose of 1.5 mg of levonorgestrel was as effective as the
standard 2-dose levonorgestrel regimen.
In a randomized controlled trial,39 a 1-dose regimen of
Ovral was less effective than the 2-dose regimen, but the
difference was not significant (54% vs. 67% for typical use
and 62% vs. 73% for perfect use). In a study that assessed
effect of Ovral on ovulation,25 it appeared that a single dose
of Ovral did not suppress ovulation as efficiently as 2 doses.
Although mifepristone is not available in Canada, it is
worth noting that it is 6 times more effective than the
Yuzpe regimen,11 even at low doses,11–14 and that very low-
dose mifepristone (unidose of 10 mg) is as effective as
levonorgestrel only.37 Mifepristone 25 mg to 50 mg is superior
to all hormonal regimens currently in use in Canada.40
 Emergency Contraception

Copper Intrauterine Device Table 2. Ovral and substitutions

A meta-analysis of 20 published papers41 showed that Pills/ EE LNG
copper IUDs inserted within 5 days of unprotected Brand 2 doses Dose, μg Dose, μg
intercourse are significantly more effective than hormonal Ovral 2 100 500
EC, with an efficacy of 98.7%. There were no pregnancies Allesse 5 100 500
in 2 studies: 1 comparing 14 emergency users of copper Triphasil 4 yellow 120 500
IUD with 219 mifepristone users,13 and another following Triquilar 4 yellow 120 500
a cohort of 1963 women obtaining a copper IUD within Minovral 4 120 600
120 hours of unprotected sexual intercourse.19 Only 1
pregnancy occurred in another descriptive study of 1013
women using copper IUDs post-coitally.18 The 2008
Cochrane Review supported the conclusion that the copper items. A 2006 study of Ontario pharmacies found that,
IUD is an excellent EC with efficacy close to 99%. 40 province-wide, levonorgestrel emergency contraception
was available in 93% of pharmacies.46 The combined oral
Timing contraceptive and copper IUD are licensed in Canada and
Effectiveness of EC appears to decline with increasing may be prescribed “off-label” for EC use.
delay between unprotected intercourse and initiation of
treatment. Levonorgestrel prevented 95% of pregnancies INDICATIONS
when taken ≤ 24 hours after intercourse, 85% within
25 to 48 hours, and 58% within 49 to 72 hours. The Hormonal EC should be considered for any woman who
corresponding figures for the Yuzpe regimen were 77%, presents within 5 days of unprotected or inadequately
36%, and 31%.1 These findings were replicated in several protected sexual intercourse and who does not wish to be
studies,11,38,42 although this timing–efficacy relationship was pregnant. Insertion of a copper IUD can be considered up
not universally seen.37,43 to 7 days after the unprotected intercourse. Unprotected
intercourse may occur because of the following:
Although their use has generally been recommended only
up to 72 hours after intercourse, the Yuzpe regimen43,44 and •• failure to use a contraceptive method
the 1 double-dose and 2-dose levonorgestrel regimens37,38
•• condom breakage or leakage
have been shown to be effective when taken between 72
and 120 hours after unprotected intercourse. •• dislodgement of a diaphragm or cervical cap
Other Factors •• 1 missed birth control pill in the first week of
Hormonal EC is less effective in women who do not combined oral contraception (SOS [Stay on Schedule]
take it according to instructions (non-perfect use) and in algorithm)47
those who have unprotected intercourse again after taking
•• 3 or more missed birth control pills in the second
it.1,12,37–39
or third week of combined oral contraception (SOS
Repetitive use of hormonal EC as a regular contraceptive algorithm)47
has not been found to provide adequate contraceptive
•• missed progestin-only pill (SOS algorithm)47
efficacy.45 In 1 study,45 women were asked to take
levonorgestrel 0.75 mg within 1 hour of each act of •• detachment of the contraceptive patch
intercourse. The overall pregnancy rate over the 6-month (SOS algorithm)47
period was 6 per 100 women-years, which was twice the
failure rate for combined oral contraceptives. Irregular •• withdrawal of the contraceptive vaginal ring
bleeding was a major drawback of this method, as it was (SOS algorithm)47
experienced by 70% of the participants.45 •• Depo-Provera injection over 2 weeks late
(SOS algorithm)47
AVAILABILITY
•• ejaculation on the external genitalia
PlanB and NorLevo are the only products currently •• mistimed fertility awareness
approved by Health Canada for emergency contraception.
Neither product requires a prescription, but availability •• sexual assault, when the woman is not using reliable
depends on the pharmacist’s willingness to stock these contraception.

SEPTEMBER JOGC SEPTEMBRE 2012 l 873

SOGC CLINICAL PRACTICE GUIDELINE
Because it is difficult to determine with certainty the
fertile time of a woman’s cycle,48–50 EC should be provided
regardless of the cycle day on which exposure occurs
if a woman is concerned about her risk of pregnancy.
Although hormonal EC is not recommended as a regular
form of contraception, repeat use poses no known health
risks and should not be a reason for denying women access
to treatment.51
CONTRAINDICATIONS
There are no absolute contraindications to the use of
emergency hormonal contraception except known
pregnancy, and this is only because it is ineffective. The
research is reassuring that these drugs are not teratogenic.
A recent study of pregnancy outcomes after LNG-EC
failure found no associated risk of malformation or other
adverse pregnancy outcomes in exposed pregnancies.52,53
Studies of pregnancies in which the fetus has been
exposed to oral contraceptives have shown no evidence
of teratogenecity,54 and exposure, therefore, is not an
indication for termination of pregnancy.
The WHO found no contraindications for hormonal
or IUD emergency contraception use in breastfeeding
women,55 and there are no known medical contraindications
to the use of hormonal EC, except allergy to 1 of the
constituents.55 Data from the United Kingdom on more
than 4 million prescriptions of the Yuzpe regimen showed
only 6 serious adverse events (3 venous thrombosis and
3 cerebrovascular events); in none of these was the
relationship between the administration of hormonal
EC and the event clearly determined.56 Women who have
contraindications to the daily use of oral contraceptives,
such as smokers over the age of 35, can safely use either
of the hormonal methods of EC, as the duration of
hormonal use is very brief.57 No substantial increased
risk for developing venous thromboembolism has been
found with combined EC, but studies of safety have
frequently excluded women who have contraindications
to oral contraception.58 As the levonorgestrel-only
regimen carries no theoretical risk, it may be a preferable
option for women who have strong contraindications
to estrogen, such as women with known thrombophilia,
history of stroke, heart attack, or active migraine with
neurological symptoms.59 There has been concern that
an excess risk of ectopic pregnancy may exist should
the progestin-only EC fail to prevent pregnancy,60 as is
seen with other progestin-only contraceptives.61Although
a few case reports of ectopic pregnancies associated
with hormonal EC have been published, a recent review
concludes that the rate of ectopic pregnancy when
874 l SEPTEMBER JOGC SEPTEMBRE 2012
treatment with emergency contraceptive pills fails does
not exceed the rate observed in pregnancies in the general
population. Because emergency contraceptive pills are
effective in lowering the risk of pregnancy, their use will
reduce the chance that an act of intercourse will result in
ectopic pregnancy.62
If a copper IUD is considered the following should be
taken into account:
•• A pre-existing pregnancy must be excluded. This may
require a urine pregnancy test or serum hCG test,
especially in women who have had sexual intercourse
at the beginning of their cycle.
•• There should be no history of recent pelvic
inflammatory disease and no apparent vaginal or
cervical infection on examination.
•• At the time of insertion, consider obtaining
endocervical specimens to test for gonorrhea and
Chlamydia.
•• Although a 2001 Cochrane Review concluded that
prophylactic antibiotics at the time of IUD insertion
were not routinely warranted, the use of antibiotic
prophylaxis in populations at higher risk for sexually
transmitted infections was shown to reduce subsequent
pelvic infection by one third.63,64 Antibiotics such as a
single dose of azithromycin (1g) or doxycycline 200
mg should be considered in women at high risk to
reduce the risk of pelvic infection.64
•• If the copper IUD fails to prevent pregnancy the
device should be removed immediately once the
diagnosis of pregnancy is made. It is also important
to rule out ectopic pregnancy.
ASSESSMENT
Very little information is required to determine whether
EC is indicated. History taking must determine that
unprotected intercourse occurred within the time frame
when EC is effective. The woman’s risk for having a pre-
existing pregnancy should be assessed by determining the
timing of her last menstrual period, that it was normal, and
that she is not currently overdue for her expected period.
Rarely will a urine pregnancy test be necessary to rule out
pregnancy. A woman who has had unprotected intercourse
earlier in the cycle may be at risk of pregnancy because
the EC therapeutic period has passed, but she should not
be denied EC if she has also had unprotected intercourse
within the 5-day window during which it is likely to be
effective.

When seeing women for consideration of EC, health care
providers should address related sexual health concerns
such as whether the unprotected act was coerced, risks for
sexually transmitted infections, and need for ongoing birth
control. Appropriate counselling, testing, and treatment
should be offered. Women should be informed about
the potential side effects and potential failure of EC and
should be advised that hormonal EC will not prevent
pregnancy from unprotected intercourse in the days or
weeks following treatment. A barrier method such as
the condom can be used for the remainder of the cycle
and a different method initiated at the beginning of the
next cycle if the woman desires. If a woman with no
contraindications wishes to start oral contraceptives,
she can be provided with a prescription to start the next
day following the use of hormonal EC or with her next
period.65 A condom should be used until she has taken the
contraceptive pill for 7 consecutive days.61
FOLLOW-UP
Women should be advised to have a pregnancy test if
they do not experience normal menstrual bleeding by
21 days following EC treatment or by 28 days if an oral
contraceptive was started after taking hormonal EC. If
indicated, a follow-up appointment can be made to address
ongoing birth control or to test for sexually transmitted
infections.
SIDE EFFECTS
The 2-dose levonorgestrel regimen has a significantly
lower incidence than the Yuzpe regimen of nausea (23.1%
vs. 50.5%), vomiting (5.6% vs. 18.8%), dizziness (11.2%
vs. 16.7%), and fatigue (16.9% vs. 28.5%).1 In the studies
comparing the 2-dose levonorgestrel regimen with the 1
double-dose regimen, the occurrence of side effects was
similar.37,38
An antiemetic has been demonstrated to reduce the risk
of nausea by 27% and vomiting by 64% when taken 1
hour before the first dose of the Yuzpe regimen.66 Expert
opinion suggests that if the woman vomits within the
first 2 hours after taking hormonal EC, the dose should
be repeated and consideration should be given to vaginal
administration of the medication.
Possible complications of the post-coital copper IUD
include pelvic pain, abnormal bleeding, pelvic infection,
uterine perforation, and expulsion.61
Emergency Contraception
RETURN OF MENSES
Most women will have their next menses within 3 weeks
of taking EC. In the 1998 WHO study,1 the onset of next
menses was similar for women taking the Yuzpe regimen
and those taking the 2-dose levonorgestrel regimen, with
15% of women having an early onset of menses, 57%
having menses return within 3 days of the expected day,
and 28% experiencing a delay of more than 3 days. In
other trials,38,39 a number of women tended to have an early
onset of menses. The time to resumption of menses may
be affected by the timing of EC in relation to the date of
ovulation.24,39
ACCESS
From a public health perspective, the promotion of EC can
be seen as primary prevention of unintended pregnancy.
To maximize the potential for EC to reduce the number of
unintended pregnancies, women at risk of pregnancy and
their partners need to be knowledgeable about EC before
they require it and able to access it quickly.
Possible barriers to the appropriate use of EC include
lack of knowledge, negative attitude, fear of side effects,
judgemental attitudes from providers, overstating of
associated health risks, impractical business hours of
medical clinics and pharmacies, and unavailability of the
product in some pharmacies. The cost of emergency
contraception is relatively high compared with other
methods and may be a barrier to access. Provincial and
territorial public health sectors should make removal of
cost barriers a priority. Making EC available without a
prescription improves access to EC.67
One randomized controlled trial68 and 2 controlled
trials69,70 have shown that, compared with women given
information only, women provided with hormonal EC in
advance of need were more likely to use it and to use it
appropriately and were not more likely to abandon regular
methods of contraception.68–70 However, a recent review of
8 randomized trials by the Cochrane Collaboration did not
demonstrate a reduction in pregnancy rates with advance
provision of EC compared with conventional provision.71
During visits to her health care provider for periodic
health examinations or reproductive health concerns, any
woman in the reproductive age group who has not been
sterilized may be counselled about EC in advance with
detailed information about how and when to use it. There
is no evidence that EC use or advanced provision of EC
is associated with future risky sexual behaviour, or sexually
transmitted infection. 71,72
SEPTEMBER JOGC SEPTEMBRE 2012 l 875
SOGC CLINICAL PRACTICE GUIDELINE
CONCLUSION
Emergency contraception has the potential to safely and
effectively reduce the number of unintended pregnancies.
The effective use of EC is dependent on increasing both
public and professional awareness and improving access
to this important therapeutic intervention. Health care
providers can encourage the appropriate use of EC by
discussing it with their patients. Professionals involved in
the promotion of women’s health must become advocates
for EC, both locally and nationally.
Summary Statements
1. Hormonal emergency contraception may be
effective if used up to 5 days after unprotected
intercourse. (II-2)
2. The earlier hormonal emergency contraception is
used, the more effective it is. (II-2)
3. A copper IUD can be effective emergency
contraception if used within 7 days after
intercourse. (II-2)
4. Levonorgestrel emergency contraception regimens
are more effective and cause fewer side effects than
the Yuzpe regimen. (I)
5. Levonorgestrel emergency contraception single
dose (1.5 mg) and the 2-dose levonorgestrel
regimen (0.75 mg 12 hours apart) have similar
efficacy with no difference in side effects. (I)
6. Of the hormonal emergency contraception
regimens available in Canada, levonorgestrel-only is
the drug of choice. (I)
7. A pregnancy that results from failure of emergency
contraception need not be terminated (I)
Recommendations
1. Emergency contraception should be used as soon as
possible after unprotected sexual intercourse. (II-2A)
2. Emergency contraception should be offered to
women if unprotected intercourse has occurred
within the time it is known to be effective (5 days
for hormonal methods and up to 7 days for a
copper IUD). (II-2B)
3. Women should be evaluated for pregnancy if
menses have not begun within 21 days following
emergency contraception treatment. (III-A)
4. During physician visits for periodic health
examinations or reproductive health concerns, any
woman in the reproductive age group who has not
been sterilized may be counselled about emergency
contraception in advance with detailed information
about how and when to use it. (III-C)
876 l SEPTEMBER JOGC SEPTEMBRE 2012
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